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Non-Small Cell Lung Cancer Library

Learn about Non-Small Cell Lung Cancer

Non-small cell lung cancer is a disease in which malignant
(cancer) cells form in the tissues of the lung.

The lungs are a pair of cone-shaped breathing organs in the chest. The lungs bring oxygen into the body as you breathe in. They release carbon dioxide, a waste product of the body’s cells, as you breathe out. Each
lung has sections called lobes. The left lung has two
lobes. The right lung is
slightly larger and has three lobes. Two
tubes called bronchi lead from the
trachea (windpipe) to the right and
left lungs. The bronchi are sometimes also involved in lung cancer. Tiny air sacs called alveoli and small tubes called
bronchioles make up the inside of
the lungs.

A thin membrane called the
pleura covers the outside of each lung and lines the inside wall of the chest cavity. This creates a sac called the pleural cavity.
The pleural cavity normally contains a small amount of fluid that helps the lungs move smoothly in the chest when you breathe.

There are two main types of lung cancer: non-small cell lung cancer and
small cell lung cancer.

See the following PDQ summaries for more information about lung cancer:

There are several types of non-small cell lung cancer.

Each type of non-small cell lung cancer has different kinds of cancer cells. The cancer
cells of each type grow and spread in different ways. The types of non-small
cell lung cancer are named for the kinds of cells found in the cancer and how
the cells look under a microscope:

Squamous cell
carcinoma: Cancer that forms in the thin, flat cells lining the inside of the lungs. This is also called epidermoid
carcinoma.

Large cell
carcinoma: Cancer that may begin in several types of large cells.

Adenocarcinoma:
Cancer that begins in the cells that line the alveoli and make substances such as mucus.

Smoking is the major risk factor for non-small cell lung cancer.

Anything that increases your chance of getting a disease
is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for lung cancer.

Risk factors for lung cancer include the following:

Smoking cigarettes, pipes, or cigars, now or in the past. This is the most important risk factor for lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer.

Being exposed to secondhand smoke.

Being exposed to asbestos, arsenic, chromium, beryllium, nickel, soot, or tar in the workplace.

Being exposed to radiation from any of the following:

Radiation therapy to the breast or chest.

Radon in the home or workplace.

Imaging tests such as CT scans.

Atomic bomb radiation.

Living where there is air pollution.

Having a family history of lung cancer.

Being infected with the human immunodeficiency virus (HIV).

Taking beta carotene supplements and being a heavy smoker.

Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

When smoking is combined with other risk factors, the risk of lung cancer is increased.

Signs of non-small cell lung cancer include a cough that doesn't go away and shortness of breath.

Sometimes lung cancer does not cause any signs or symptoms. It may be found during a chest x-ray done for another condition. Signs and symptoms may be caused by lung cancer or by other conditions. Check with your doctor if you have any of the following:

Chest discomfort or pain.

A cough that doesn’t go away or gets worse over time.

Trouble breathing.

Wheezing.

Blood in sputum (mucus coughed up from the lungs).

Hoarseness.

Loss of appetite.

Weight loss for no known reason.

Feeling very tired.

Trouble swallowing.

Swelling in the face and/or veins in the neck.

Tests that examine the lungs are used to detect (find), diagnose, and stage non-small cell lung cancer.

Tests and procedures to detect, diagnose, and stage non-small cell lung cancer are often done at the same time. Some of the following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, including smoking, and past jobs, illnesses, and treatments will also be taken.

Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Sputum cytology: A procedure in which a pathologist views a sample of sputum (mucus coughed up from the lungs) under a microscope, to check for cancer cells.

Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.

If lung cancer is suspected, a biopsy is done.

One of the following types of biopsies is usually used:

Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.

An endoscopic ultrasound (EUS) is a type of ultrasound that may be used to guide an FNA biopsy of the lung, lymph nodes, or other areas. EUS is a procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.

Mediastinoscopy: A surgical procedure to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.

Anterior
mediastinotomy: A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and heart for abnormal areas. An incision (cut) is made next to the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. This is also called the Chamberlain procedure.

Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the lymph node tissue under a microscope to check for cancer cells.

One or more of the following laboratory tests may be done to study the tissue samples:

Molecular test: A laboratory test to check for certain genes, proteins, or other molecules in a sample of tissue, blood, or other body fluid. Molecular tests check for certain gene or chromosome changes that occur in non-small cell lung cancer.

Immunohistochemistry: A laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient’s tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (the size of the tumor and whether it is
in the lung only or has spread to other places in the body).

The type of lung
cancer.

Whether the cancer has mutations (changes) in certain genes, such as the epidermal growth factor receptor (EGFR) gene or the anaplastic lymphoma kinase (ALK) gene.

Whether there are signs and symptoms such as coughing or trouble breathing.

The patient’s general health.

For most patients with non-small cell lung cancer, current
treatments do not cure the cancer.

If lung cancer is found, taking part in one of the many clinical
trials being done to improve treatment should be considered. Clinical trials
are taking place in most parts of the country for patients with all stages of
non-small cell lung cancer. Information about ongoing clinical trials is
available from the NCI website.

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